Janet Ajuluchukwu is a professor of Medicine and consultant cardiologist at the College of Medicine, Lagos University Teaching Hospital (LUTH). With over 35 years of practice, she has performed open-heart surgeries and carried out many delicate medical services. In this interview with CHINWE MADUAGWU, the renowned cardiologist speaks on a wide range of issues including the fact that men are more predisposed to hypertention than women.
NE: How did the journey to becoming a doctor and a cardiologist begin?
It was in primary four when I first had the inclination I may be a doctor. At the time, when my father wanted to caution or correct me, he would say, ‘that’s not how a doctor would do.’ I cannot say where the interest came from – whether it was from those words or from me. However, I remember that was how he used to caution me while in primary school and I began to do things I thought a doctor would do. Even in our playgroups, we used to operate on grasshoppers and see how they fed because we felt that was how doctors would behave.
NE: So, we can infer that your father was a great influence on you becoming a doctor
Yes, he was.
NE: Did that not surprise you because, at that time, women were mostly involved in traditional jobs like teaching, nursing or simply homemakers?
I am the last born in my family. My eldest sister is a nurse who went as far as sub-specializing in ear, nose, and throat (ENT) Nursing in Scotland. My father was a British trained nurse. I do not think there was a role assignment based on what prevailed at the time. Everybody was encouraged to do his or her best.
NE: You used to perform surgery on grasshoppers in your primary school. Why are you a cardiologist now and not a surgeon?
While in secondary school and still trying to answer the first question, I was not very sure I wanted to be a doctor. I felt strongly to be a doctor in my primary school rather. I even left it to fate by waiting to see how my WAEC result would be. Funnily, I scored similar marks in both science and arts subjects and so in trying to go to higher school; I went for the medical subjects – Chemistry, Physics, and Biology. When I got those subjects, I lost interest in other things. At that time too, I was interested in French and my French teacher used to say I was the best French student she had ever taught.
Coming to why I am a cardiologist and not a surgeon, I got prizes in Surgery during my undergraduate days. In the final year, I got the Ali Idowu Prize for Surgery for my class and everybody thought I would be a Surgeon. After national service, I had a chance to work at the Medical Emergency Room in preparation for doing the requisite exams for Residency. That emergency room experience made me keep an interest and a senior colleague made some comments that got me attracted to that aspect of medicine more than Surgery and that kept me on the side of Internal Medicine. Cardiology just seems to come naturally to me. It is very technical and mathematical. I think that is how my pathway was arranged. I have been a Cardiologist since 1993.
NE: How has it been for you these 24 years as a Cardiologist?
It has been very interesting. We have an array of different health issues in Nigeria. Cardiology is a disease guided by westernisation and industrialisation. Africa is currently being described as a double burden continent. We have not finished clearing our infective agents like malaria, tuberculosis, HIV, and now we are being burdened with the problems of civilisation. If you take a typical place like England, America or Sweden, they would have a minimal rate of infectious diseases. For instance, if they record, say ten tuberculosis infection for the whole country, it would be news while these problems are still in Nigeria. We have not cleared these infections and now we are facing the problems brought about by industrialisation. We are still grappling with our infective problems and some of them affect the heart, like tuberculosis. Therefore, we have patients with double prevalence, double co-existence of infections and what we call emerging diseases and it is really interesting trying to deal with such cases.
NE: Are you saying there is a relationship between westernization, industrialisation, urbanisation and the heart problems we see in Africa and in Nigeria in particular?
Yes. The profile of the medical problems the world has been encountering is in phases. Most communities or countries would have to go through what is called diseases of pestilence. These are diseases like malnutrition, infection, malaria, cholera, undernutrition etc. But as man got better and more scientific and started using implements, cooking food, having stable families, our lifestyle changed. Now our mode of movement ambulation has changed. Instead of walking to the farms by 5 am and working on the farm and returning home by 7 pm, we drive. At the worst, an Okada or Keke will carry you wherever you want to go. Nobody is on the farms, so our lifestyle has changed from being very physical to sedentary and without gainsaying, the pattern of diseases have also changed.
We are now having problems of degeneration so things like poverty, poor nutrition and infections have moved away. If you go the Western countries, nobody is talking about malaria, rather the profile of diseases has moved to these newer diseases like hypertension, diabetes, arthritis, strokes, diseases that do not have an infective process. These new diseases are multi-factorial. If a mosquito bites you, you get a disease called malaria. However, a conglomeration of behavioural risk factors causes these new diseases. So the industrialised countries are having hypertension, heart attacks, strokes, diabetes etc. They hardly ever have infections. Africa is the seat of all infections and for many reasons such as policy and poverty we have not cleared them but we are also acquiring the lifestyle of the Western world and now having the diseases of pestilence and the diseases of affluence coexisting at the same time. Most of our lifestyle changes are from industrialisation, westernisation and what we eat.
NE: Do you agree with the saying ‘when the diet is wrong, medicine is of no use and when the diet is right, medicine is of no use?’
Yes. The saying may be a paraphrasing of what Hippocrates, Father of Medicine said a long time ago, ‘Let food be your medicine.’ Some people have taken it one step further to say ‘you are what you eat.” I do not really believe that but if you go through what we call the risk factors of cardiovascular diseases, there are those we say are non-modifiable and those that are modifiable. The non-modifiable factors include genetics, age, and gender while the modifiable ones are behvioural for instance you would want to smoke a cigarette or not smoke, then your salt intake. Salt, as we know, is a preservative and the more already made or imported food you take especially in the cities, the more salt you eat from the preservative. It has already been proven that when people move from the rural area to the urban areas, within three months, their blood pressure will shoot up and this is traceable to what they eat until the time they have a more stable home and begin to cook their own food. Lack of fruit and vegetable intake is also a factor. Fruits and vegetables are rich in potassium, which tends to neutralise the effects of sodium (salt).
NE: Let us zero in on hypertension here. You described gender and genetics as risk factors for cardiovascular diseases. Is any of the gender more prone to hypertension than the other?
Well, the male gender is a risk factor. Through many studies and researches, we know that the male sex is a risk factor for hypertension. For instance in Nigeria and in most of the geographical zones where tests were done, it was seen that men would have higher blood pressure prevalence than the women but in certain places you see it coming closer. However, in textbooks, the male gender is supposed to be more prone to hypertension.
NE: Is there anything in the male anatomy that you can say makes them more prone to hypertension?
Generally, we think that the female hormones are protective. Even for certain problems to afflict man and woman, especially the heart attack type of story, the women appear to be highly protected. However, after the natural menstruation ceases or somebody has what is called a surgical termination of menstruation, their risk factors come up. So, there is evidence that the female hormones are protective. Does it mean the male testosterone is adverse; there is a lot of debate about that.
NE: Does it then mean that every man will at some point be hypertensive?
No. It is not invariable. We have the interaction of genes, behavior and the environment. In the Koma people who did not eat salt at the time of discovery, nobody had hypertension. But we learnt that since they were exposed to eating bread, biscuits, using cooking salt, their profile has changed.
NE: Looking at genetic makeup, can we say hypertension is hereditary?
Yes. It is hereditary but we call it Lock and Key Model. Even though the genes are there, if you do not eat salt, do not smoke or you do not allow yourself to get obese, you may not necessarily manifest.
To be continued ….